Hospital On-Call Coverage Program

HOCC Guidelines and Eligibility Criteria


General

  1. Funding from the HOCC initiative shall be made on the basis that a physician can only be registered for HOCC at one hospital or one hospital site, and only for one specialty.
  2. A first-call after-hours on-call rota must currently exist and continue to function for the specialist group seeking HOCC coverage. Specific funding for back-up coverage, i.e. second call, is not provided.
  3. A physician can only receive one HOCC payment per on-call shift, even if multiple sites or specialties are being covered concurrently. HOCC funding is provided for on-call availability, which does not change under these circumstances.
  4. Locums, physicians on alternate funding arrangements or physicians being compensated through a contract with provisions for on-call are not eligible for HOCC funding.
  5. The Level IV specialist payments are for special visits for the provision of non-elective/emergency assessments and procedures in the evenings, nights, on weekends or holidays. The specialist is limited to two call-in fees per calendar day.
  6. This agreement is not intended to affect the traditional patterns of hospital on-call coverage currently being provided by the physicians.
  7. Hospital on-call is defined as being available to provide timely access to medical care to hospital patients after-hours. After-hours is defined as Monday to Friday 1700-0700 hours and Saturday, Sunday and holidays all day as outlined in the Schedule of Benefits.
  8. Funding for Critical Care Medicine is limited to intensivists providing coverage to closed critical care units (ICU), who are not part of an alternate funding arrangement and who are not listed for HOCC for another specialty.
  9. For medical sub-specialties such as Endocrinology, Nephrology, Critical Care and Geriatric Medicine, after-hours on-call rotas seeking HOCC funding must be first on-call, completely separate from the Internal Medicine and/or any other on-call schedule.
  10. HOCC funding for General and Family physicians is limited to those physicians providing on-call to the hospital. Examples of General and Family practice on-call services provided may include but are not limited to surgical assistants, broad based obstetrical coverage, and admission and care of unassigned patients.
  11. Physicians may not limit their on-call availability strictly for their own patients or for those in their own group or practice.

Eligibility Criteria for Second HOCC Stipends in Approved Specialties

The departments of General and Family Medicine, Anesthesia, Obstetrics and Gynecology, General Internal Medicine and Pediatrics (Neonatal Intensive Care units only) may be eligible for a second stipend so long as they meet the following criteria:

  1. The department seeking the second stipend must have at least ten active members providing after-hours hospital on-call coverage (there do not need to be ten physicians on each of the two call schedules);
  2. The rotation seeking the second HOCC stipend must be first on-call (i.e. two physicians must be providing first on-call after-hours coverage to the hospital at all times). Funding for second call, i.e. back-up coverage, is not provided;
  3. The two rotas must operate concurrently and separately from one another with no cross-coverage. When applying for the second stipend, copies of both on-call rotation schedules must be submitted to clearly demonstrate that the two physician groups operate separately; and,
  4. Seamless call must be provided by both rotations

Eligibility Criteria for Level II Interim Enhanced ED Backup On-Call

  1. Emergency department groups must be in Hospitals designated for 24-hour on-site ED physician coverage.
  2. The emergency department must have a distinct published physician backup on-call roster and protocol with 24/7/365 coverage with no gaps. The backup on-call roster must be provided to the Ministry/HOCC Committee on request.
  3. Eligibility for funding for ED backup coverage assumes that there be no gaps in scheduled ED coverage:
    1. Gaps in scheduled ED coverage will result in reductions (pro-rating) of HOCC – ED Backup On-Call funding appropriate to circumstance.
    2. Frequent gaps in scheduled ED coverage will result in withdrawal of HOCC – ED Backup On-Call funding.
    3. New groups (i.e. those not currently registered for Interim Enhanced HOCC) must commit to the Interim Enhanced HOCC Program prior to pursuing an application for Level II ED Backup On-Call funding.
    4. A set of criteria that establishes when to call in the ED backup physician, approved by the Chief of Emergency Medicine and accounting for local variations in circumstance, must be in place at each Hospital and be available to the Ministry/HOCC Committee on request.
    5. The backup on-call onsite response time must be 30 to 60 minutes as local circumstances dictate

Eligibility Criteria for Level II Intra-Sectional Allocations (ISAs) of HOCC Funding for Cardiology, Neurology, Ophthalmology and Otolaryngology

Eligibility Criteria for Level II Intra-Sectional Variability of HOCC Funding for Cardiology/Neurology

  1. The department seeking the change from Level III HOCC funding to Level II HOCC funding must have at least four active members providing after-hours on-call coverage.
    Note: In very specialized circumstances, groups of less than four may be considered for Level II funding on a case-by-case basis.
  2. The group must provide direct first call after-hours to the Emergency Department (i.e. not backup to the Internist on-call). Groups wishing to apply for an ISA must directly answer to the ER physician, GP or other appropriate designated staff (e.g. the Charge Nurse when the Cardiologist/Neurologist is the most responsible physician), and come in to the hospital when clinically indicated to be considered for Level II funding. Members of the call group must directly answer pages to the emergency department and in-patient areas for problems in their specialty. Calls cannot be "filtered" by the General Internist.
  3. The department must provide letters of support from the Department Chief and the Chief of Emergency Medicine or the MAC Chair to confirm that the particular group provides direct first call independent of the General Internal Medicine call schedule.
  4. The department must provide call schedules for a three-month period for both General Internal Medicine and the sub-specialty group seeking the change in HOCC Level (i.e. Cardiology or Neurology) to demonstrate that there is no overlap and no cross-coverage. Physicians’ names may not appear on both schedules. A physician may only be registered for HOCC at one hospital, and for only one service.
  5. Physicians applying for consideration to be moved to Level II HOCC funding must agree to participate as a group, not as individuals.
  6. Groups not wishing to participate at Level II will remain at Level III with their existing call/practice arrangements. Groups that have the Internist on call dealing with all after- hours issues and only provide a response to the Internist may continue this practice without any change in their HOCC status.

Eligibility Criteria for Level II Intra-Sectional Variability of HOCC Funding for Ophthalmology/Otolaryngology

In order to be eligible for Level II funding one of the following three criteria (A or B or C) must be met:
A) Hospitals that are geographically capable of forming regional call groups must agree to do so and should be prepared to include 3 or more hospitals with 5 or more members of their specialty or
B) Tertiary hospitals that have 4 or more specialists and currently do not share call with another hospital (i.e. are not in a regional group) will be eligible or
C) The hospital is geographically isolated and cannot form a regional call group.
In Addition:

  1. All regional groups or hospitals receiving Level II funding should expect referrals from hospitals close to their region that do not have specialty coverage.
  2. Calls to the regional call group must be responded to in a timely fashion. Patient referrals from the region expedited through Criticall will be managed using a “best efforts” approach for patient care within the region, or failing availability of resources, providing advice to aid in patient transfer out of the region.
  3. The surgeons involved may only be registered for HOCC funding at one hospital and for one service. The hospitals involved in the regional call arrangement must together designate one hospital and one contact to be responsible for submitting the application and distributing the HOCC funding. For purposes of HOCC funding, physically or geographically separate buildings will constitute separate hospital sites.
  4. Each regional group will be entitled to one Level II stipend that may be divided through local or regional arrangements, however the group decides, as long as there is someone on call for all hospitals in the group for any given shift. For example, a regional group of three hospitals with three specialists in each hospital would receive one Level II HOCC stipend for 5+ physicians to be divided among the 9. There could be regional coverage for the entire week, or there could be an arrangement where each hospital has local coverage during weeknights and regional coverage on weekends. All three hospitals would have coverage for every after-hours shift, whether on a local or regional basis, as decided by the group with agreement by the MACs.
  5. There can be no concurrent cross-coverage within the same hospital or between regionally covering groups.
  6. The group must provide direct first call to the ER and Inpatient Units. Members of the call group must directly answer pages to the emergency department and in-patient areas for problems in their specialty. Calls cannot be "filtered" by another specialist. HOCC funds direct first-call coverage only.
  7. The Departments of the involved hospitals must provide letters of support from their respective Chiefs of Emergency Medicine and/or MAC Chairs to confirm that the particular group provides direct first call.
  8. Physicians applying for consideration to be moved to Level II HOCC funding must agree to participate as a group, not as individuals.
  9. Groups participating in Level II regional coverage will be subject to the same requirements as other Level II specialists.
  10. Groups not participating in Level II regional coverage will continue to be eligible for Level III funding.
Note : Those Ophthalmologists providing emergency retinal surgery on separate call schedules may also apply for Level II status through direct application to HOCC; however they can only be registered for one HOCC stipend.

For purposes of HOCC funding, “retinal surgeons” will be defined as Ophthalmologists with greater than $70,000 billings in retinal/vitreol surgical services and greater than $4,000 in retinal/vitreol after-hours billings at one of the five main centres. Please contact the HOCC Program for further advice.


Rurality Premium


HOCC provides premiums for rural physicians as follows. Each hospital eligible per the 2008 OMA Rurality Index of Ontario (i.e. with a rurality index greater than 45) shall receive an annual financial incentive of $15,000 (less $75 - see note) for GP on-call funding. This incentive is in addition to the on-call funding as set out in the MOHLTC-OMA Agreement.


GP/Anaesthesia Premium

The GP/Anesthesia premium is intended to assist in retaining GP/Anesthetists in rural communities. Each eligible hospital (as determined by the HOCC Administration) that does not have a Royal College certified anesthetist associated with it and where general practitioners provide a minimum of $10,000 of anesthetist services per year will receive an additional $15,000 (less $75 - see note) annually. This incentive is in addition to the on-call funding as set out in the MOHLTC-OMA Agreement.


Note: In accordance with the negotiated terms of the 2012 Physician Services Agreement (2012 PSA) between the Ontario Medical Association and the Ministry of Health and Long-Term Care, a 0.5% discount has been applied to physician payments effective April 1, 2013. As per the 2012 PSA, this discount may be reduced if additional savings are identified in the physician services budget.

For More Information

Toll Free : 1-866-684-8620
E-Mail : OnCall@ontario.ca